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Myocardial injury after non-cardiac surgery (MINS), detected by elevated troponin measurement, is a common postoperative complication and increases the risk of 30-day mortality by three times.1 In The Lancet, P J Devereaux and colleagues2 report the results of the MANAGE trial, a randomised, placebo-controlled study investigating use of the direct oral anticoagulant dabigatran in 1754 patients with MINS. Eligible patients were aged at least 45 years, had undergone non-cardiac surgery, and were within 35 days of MINS.